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Medication-Assisted Treatment in Correctional Facilities

The percentage of inmates in federal and state prisons who suffer from substance use disorders is astounding. Around 60-80% of people who are incarcerated struggle with either an opioid or alcohol addiction. Programs such as, Medication-Assisted Treatment (MAT), have been put in place to help combat the opioid crisis.

Medication-Assisted Treatment is defined as the use of medications in combination with counseling and behavioral therapies. This provides a “whole patient” approach to the treatment of substance use disorders. It is primarily used for the treatment of addictions to opioids (heroin and prescription pain relievers that contain opiates.) The prescribed medication normalizes the brain chemistry and blocks the euphoric effects of opioids. It also relieves the psychological cravings without the withdrawal symptoms. MAT is approved by the FDA and is clinically driven and tailored to meet each patient’s needs. However, it should not be combined with anxiety medications or it could be fatal.

Opioid Treatment Programs (OTP) provide Medication-Assisted Treatment for individuals diagnosed with an opioid use disorder. They also provide a range of services in order to reduce, eliminate, and prevent the use of illicit drugs, potential criminal activity, and the spread of infectious diseases. They must be accredited by a SAMHSA approved accrediting body. SAMHSA is the Substance Abuse and Mental Health Services Administration under the U.S. Department of Health and Social Services which leads public health efforts in reducing the impacts of substance abuse and mental illness in the United States.

The Federal law requires patients who are receiving MAT in an Opioid Treatment Program to also receive medical, counseling, vocational, educational, and other assessment and treatment services in addition to prescribed medication. Treatment can be provided in a range of settings such as hospitals, correctional facilities, offices, and remote clinics.

MAT’s ultimate goal is full recovery. It has been shown to improve patient survival, increase retention in treatment, decrease illicit opiate use and other criminal activity of people who suffer from substance use disorders, increase the patient’s ability to gain and maintain employment, improve birth outcomes with women who are pregnant and have a substance use disorder, and it can contribute to lowering a person’s risk of contracting HIV or Hep-C because they are not sharing needles by reducing the potential for relapse.

The drugs that are used in MAT do not substitute one drug for another. They are used to help suppress cravings so that you are not feeling any withdrawal symptoms or the feeling of euphoria as if you were taking opioids. Methadone is one drug used in MAT that tricks the brain into thinking it is still getting the abused drugs, but the person is not getting high off it and feels normal. Withdrawal does not occur while using methadone. Buprenorphine is like Methadone and suppresses and reduces the cravings for the abused drug. Naltrexone is another medication but is completely different from the aforementioned prescriptions. If a person relapses and uses the abused drug, Naltrexone blocks the euphoric and sedative effects to the brain and prevents the feeling of euphoria.

Maine’s state prison in Rockland adopted MAT practices last month. There are now 178 inmates there who are getting treatment for their substance use disorder. MAT is available for inmates who received medication before they were incarcerated and for inmates who are six months from release, but as long as they have a clinician’s consent. At the end of last year, 115 inmates who participated in these programs have been released, with 84% of those inmates attending their first community-based treatment.

There is one big issue related to MAT inside correctional facilities. Some individuals getting the treatment may divert their prescribed medications in the black market within the facility. They do this in the form of cheeking, which is storing pills, liquids, or films inside the cheek of their mouth to later redistribute. It’s a serious concern because, one, it results in the nonmedical use of medications and, two, it can lead to altercations and violence when the redistributed medications do not have the sought aftereffects of the abused drug normally has.

SAMHSA put out several steps that jails can take to effectively reduce and control the diversion of the drugs used in MAT programs. Staff need to be fully dedicated to implementing MAT programs because they require much attention to detail and high levels of coordination. The second step jails should be taking is to have multidisciplinary teams, a team of staff from both inside and outside the facility in order to safely deliver medications into the right hands and prevent the diversion of medication. This creates trust in order to reduce mistakes, increase transparency, and minimize the risk of diversion. There also needs to be collaboration between medical staff, treatment providers, correctional staff, and the patient receiving treatment to have a plan that centers around the patient. This could include a consent in writing. Another step is to ensure the safe administration of medication in order to prevent cheeking and redistribution of medications. This includes dual checks performed by correctional staff as well as medical staff, dedicated observation tables, a specialized unit for MAT inmates, and/or transportation to a from a MAT facility to secure proper treatment. Finally, the next three steps are to respond effectively to incident reports, provide on-going training to staff to ensure they are always practicing best practices, and to establish partnerships with community-based providers.

Medication-Assisted Treatment has been proven to be extremely beneficial to those suffering with a substance use disorder. There should be more programs like the one in Maine in all and any correctional facilities to support inmates who struggle with addiction. This will help inmates to not immediately go back to drug use after they are released and reduce the threat of overdosing.

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